Paramedicine Collaborative Helps Patients and Reduces Overutilization

When people with complex medical and social needs have little support or resources, they may rely on emergency service providers for nonemergent care and even companionship. These high utilizers can overburden emergency medical services and emergency departments, preventing them from addressing true emergencies. The Pierce County Paramedicine Collaboration is a community-driven project to reduce overutilization of emergency medical systems and hospital services by high utilizers while improving their health outcomes.

Charlie, a 78-year-old retired Air Force veteran who suffers from heart failure, diabetes and prostate cancer, was once a high utilizer. His wife of over 50 years had died and he didn’t have any children. He lived alone and struggled to care for himself — forgetting to take his medications, missing doctor appointments and falling down. Charlie’s solution was to call 911 when he needed help — with taking his medications and with getting up when he fell — or when he was lonely. Sometimes he called twice a week. 911 became Charlie’s doctor and all-around support system.

The Pierce County Paramedicine Collaboration brings together county EMS, an independent physicians’ group, payers and local providers to help high utilizers like Charlie using a three-pronged approach:

EMS identifies high utilizers and refers them to the physicians’ group for case management. Case managers match patients with appropriate health care systems, including primary care; identify any specialty health needs, such as food insecurity; and provide encouragement for ongoing health activities.

For the highest of high utilizers — more than 50 ED visits in one year — interdisciplinary teams take part in wellness meetings to develop a plan for care and social services tailored to the patient’s unique needs.

EMS connected Charlie with the Pierce County Paramedicine Collaboration. Soon he received a visit from the fire department and a case manager from his primary care network. During the visit Charlie revealed that he ate only one meal a day and his driver’s license had been suspended. He said he wasn’t sure what some of his prescriptions were for.

Charlie’s life quickly began to change for the better. Fire department staff gave him rides to doctor’s appointments until he was able to use a shuttle service. Meals on Wheels delivered healthy, regular meals. A palliative care physician came to his home each month to help him understand and organize his prescriptions. A volunteer visited regularly to provide companionship and take him shopping. Charlie was smiling more, feeling better and living a higher quality life.

Charlie is just one of hundreds of patients who have benefited from this project that has shown remarkable results. Analysis by Comagine Health has revealed reductions in:

EMS calls — 44%

EMS transports — 47%

ED visits — 36%

Hospital admissions — 42%

Observation stays — 31%

Not only are vulnerable individuals with complex, chronic conditions healthier and happier, emergency workers and resources have been freed up to take care of others in the community, and EMS staff are experiencing greater job satisfaction.